| NPI | 1235628207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020674) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CO AT.0002810) |
| Enumeration Date | 2018-05-05 |
| Last Update Date | 2026-02-18 |